BEUDAMED
    FDA Adverse Event Injury Summary report: N

    3M AVI

    MDR report key: 91519 · Received August 15, 1994

    Report

    Report Number
    91519
    Event Type
    Injury
    Date Received
    August 15, 1994
    Date of Event
    April 19, 1994
    Report Date
    May 3, 1994
    Manufacturer
    3M HEALTH CARE
    Product Code
    FRN
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    WV, US
    Reporter Occupation
    PHARMACIST

    Narratives

    Description of Event or Problem · 1

    IV TUBING DISCONNECTED FROM PUMP ALLOWING FREE FLOW OF LIDOCAINE INFUSION. PT EXPERIENCED SEIZURES, REQUIRED INTUBATION AND RESPIRATORY SUPPORT. FULL RECOVERY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 3M AVI INFUSION PUMP FRN 3M HEALTH CARE 400A *

    Patients

    Seq Age Sex Outcome Treatment
    1 51 YR Life Threatening| R